Provider Demographics
NPI:1073935326
Name:HOPE LIVES - VIVE LA ESPERANZA
Entity Type:Organization
Organization Name:HOPE LIVES - VIVE LA ESPERANZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KURKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-208-4010
Mailing Address - Street 1:1551 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-2413
Mailing Address - Country:US
Mailing Address - Phone:480-208-4010
Mailing Address - Fax:602-388-1567
Practice Address - Street 1:2308 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3709
Practice Address - Country:US
Practice Address - Phone:480-208-4010
Practice Address - Fax:602-388-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA13ADHS02123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health